IV IV Nutrition & Blood Products 2 — Questions and Answers
Question 1: What is 'refeeding syndrome' and when is it most likely to occur with TPN?
- Fluid overload from TPN lipid infusions
- Dangerous electrolyte shifts (especially hypophosphatemia) when nutrition is reintroduced to severely malnourished patients (Correct answer)
- Hyperglycemic crisis from excess TPN dextrose in all patients
- Infection from contaminated TPN admixtures
Correct answer: Dangerous electrolyte shifts (especially hypophosphatemia) when nutrition is reintroduced to severely malnourished patients
Refeeding syndrome occurs when malnourished patients receive TPN, causing rapid intracellular phosphate shifts that result in life-threatening hypophosphatemia, hypokalemia, and hypomagnesemia.
Question 2: A patient receiving TPN develops a fever, chills, and elevated WBC. The TPN bag appears cloudy. What is the most appropriate action?
- Continue TPN and administer antipyretics
- Discontinue the TPN infusion, retain the bag for culture, and insert a new IV with fresh TPN after physician evaluation (Correct answer)
- Filter the TPN through a 0.2-micron filter and continue
- Reduce TPN rate and reassess in 2 hours
Correct answer: Discontinue the TPN infusion, retain the bag for culture, and insert a new IV with fresh TPN after physician evaluation
A cloudy TPN bag with systemic signs of infection suggests contamination; the infusion must be stopped, the bag retained for culture, and new TPN obtained after medical evaluation.
Question 3: What is the primary purpose of lipid emulsions in total parenteral nutrition?
- To provide electrolyte supplementation
- To supply essential fatty acids and a concentrated caloric source for energy (Correct answer)
- To prevent catheter occlusion in central lines
- To buffer the high pH of dextrose solutions
Correct answer: To supply essential fatty acids and a concentrated caloric source for energy
Lipid emulsions in TPN provide essential fatty acids (linoleic and linolenic acid) and a calorie-dense energy source that reduces dextrose load and prevents essential fatty acid deficiency.
Question 4: Febrile non-hemolytic transfusion reaction (FNHTR) is caused by which mechanism?
- ABO incompatibility between donor and recipient
- Recipient antibodies reacting against donor leukocytes and cytokines in the blood product (Correct answer)
- Bacterial contamination of the blood product
- Fluid overload from rapid transfusion
Correct answer: Recipient antibodies reacting against donor leukocytes and cytokines in the blood product
FNHTR is caused by recipient antibodies directed against donor white blood cell antigens and/or cytokines accumulated during storage, producing fever and chills without hemolysis.
Question 5: A patient has an order for 2 units of fresh frozen plasma (FFP). The nurse knows that FFP must be transfused within how many hours of thawing?
- 1 hour
- 4 hours
- 24 hours (Correct answer)
- 72 hours
Correct answer: 24 hours
Thawed FFP must be transfused within 24 hours (some institutions allow thawed plasma within 5 days) to preserve coagulation factor activity.
Question 6: Transfusion-associated circulatory overload (TACO) is most likely to occur in which patient population?
- Young healthy adults receiving elective transfusions
- Elderly patients with cardiac or renal impairment receiving rapid transfusions (Correct answer)
- Pediatric patients receiving autologous blood
- Patients receiving single-unit transfusions over 4 hours
Correct answer: Elderly patients with cardiac or renal impairment receiving rapid transfusions
TACO occurs when transfused volume exceeds cardiac capacity; elderly patients with preexisting cardiac or renal dysfunction are at highest risk.
IV IV Nutrition & Blood Products 2
What is 'refeeding syndrome' and when is it most likely to occur with TPN?